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Appeals Specialist

Generis Tek Inc. Glen Allen ,VA
  • Expired: over a month ago. Applications are no longer accepted.
Job Description: We have a Contract role Appeals Specialist our client Glen Allen, VA. Please let me know if you or any of your friends would be interested in this position. The Position title: Appeals Specialist - 2020-24969-Glen Allen, VA Location : 4991 Lake Brook Dr, Glen Allen, VA 23060 Duration : 2 months Pay rate : $19.00 / hr Temporary Appeals Specialist Needed: · The Appeals Specialist is responsible for appealing insurance payments limited by a UCR adjustment. · This process could be on behalf of the parent or in conjunction with a parental appeal. · On a daily basis, the associate will review accounts, identify any appealable charges, and post appropriate transaction code for follow up. · The collections effort on appealed accounts includes; telephone contact with payers, employer benefit managers and parents, working daily and monthly reports, researching and reviewing state statutes that would present an arguable case on the companies behalf and developing and submitting cover letters with appeal packets to payer or parent for additional reimbursement. · Performs required tasks on GPMS, Excel and Word. Qualifications: · Associate's degree (A. A.) or equivalent from two-year college or technical school; or one to two years related experience and/or training; or equivalent combination of education and experience. · Ability to research and interpret state laws as they pertain to the collection of fees for services rendered. · Ability to draft appeal letters to be sent to parents or insurance companies. · Ability to communicate professionally and thoroughly with staff, parents, insurance companies, business partners and other parties. · Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to effectively present information and respond to questions from customers and the general public. · Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to calculate figures and amounts such as discounts and percentages. · Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to define problems, collect data, establish facts, and draw valid conclusions. Responsibilities: · Make necessary telephone or written contact. · Contact payers to dispute underpaid accounts which are >$1,000. · Develop cover letters to submit with appeal packets to payers. · When necessary, obtain Assignment of Benefit Form from parents to appeal directly with the insurance company. · Follow up monthly on packets forwarded for appeals to assure additional monies recovered. · If no additional monies paid, assure information logged to provide a record to monitor future appeal denials for the same issue. · Consistent follow-up on identified short paid accounts through working daily and monthly appeal reports. · Analyze the Daily Allowable Audit Report, which provides a listing of accounts which reflect charge line(s) with UCR indicated. · Analyze the Appeals Report on a monthly basis, which identifies charges with a primary Commercial payer and has an insurance payment less than the charge amount. · Run report monthly of specific transaction message codes to evaluate progress of appeals. · Maintain a spreadsheet which shows a 12 month span of appeal money identified and then if it was collected or adjusted off. · Communicates with the Regional management team on the findings associated with the Appeals Queue. · Reviews on a monthly basis, accounts in the Appeals Queue and reports collection efforts by payer. · Requests from the Financial Analyst detail reports from the Brio Cube, sorted in various ways, to follow up on appeals by the payer. · Develops a plan of action for appealing repetitive payment reductions by a payer. · Carry out action plan. · Perform audits on accounts. · Review accounts for accuracy (ie; payments have been posted correctly, appropriate adjustments have been made, etc.) · Process adjustments as necessary if audit review warrants. · Posting of Appealed Accounts · For each account that has an appeal charge identified, enter proper document identification to track additional appeals collections. · Manages accounts placed with Everest Appeals Agency ensuring timely resolution and final disposition of account. · Update accounts as necessary · Update accounts in GPMS with information obtained through correspondence and telephone (ie; authorization, address, baby’s name, etc.) and notate appeal efforts. · Completes appropriate account maintenance by ensuring that the correct statement groups, financial class, etc are on account. · Meet or exceed required departmental productivity standards on a consistent basis. · Assure all accounts reflecting requiring appeal are processed for additional payment consideration during the month. · Performs a variety of other collection duties. · Assists on various special projects as determined by the Manager. · Always meets deadline dates and times on assigned projects. · Work overtime in mandatory situations. · Maintain strict confidentiality. · Any patient information must not be divulged on any account except to payers that need the information in order to process the claim. · Any information relayed in confidence must not be divulged to any third party(s). · Presents a positive, professional appearance and conveys a professional demeanor in the performance of assigned duties. · Performs other job-related duties within the job scope as requested by Management of Patient Accounts. If you are interested in this opportunity, please email your resume at jobs@generistek.com and include posting 20-00984 in your application. Also, you can call us at # 630 576 1921 and to discuss this position in detail. About Generis Tek:Generis Tek is a boutique IT/Professional staffing based in Chicagoland. We offer both Contingent Labor & Permanent placement services to several Fortune 500 clients Nationwide.Our philosophy is based on delivering long-term value and build lasting relationships with our clients, consultants and employees. Our fundamental success lies in understanding our clients’ specific needs and working very closely with our consultants to create a right fit for both sides. We aspire to be our client’s most trusted business partner. Company Description: At Generís Tek we are constantly evolving to help talented professionals map their careers. We provide a competitive, fast-paced environment that promotes open communication to form a long term relationship built on mutual understanding, respect and trust. We at Generís Tek very highly value our relationship with our consultants. What sets us apart is the high level of service we provide to our clients after each employee is placed. Our dedicated professionals help you in reaching your career objective. Let’s connect and realize your goal.

Generis Tek Inc.

Why Work Here?

Generis Tek provides a competitive, fast-paced environment that promotes open communication to form a long term relationship.

At Generís Tek we are constantly evolving to help talented professionals map their careers. We provide a competitive, fast-paced environment that promotes open communication to form a long term relationship built on mutual understanding, respect and trust. We at Generís Tek very highly value our relationship with our consultants. What sets us apart is the high level of service we provide to our clients after each employee is placed. Our dedicated professionals help you in reaching your career objective. Let’s connect and realize your goal.

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Glen Allen, VA
USA

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